WO2014136045A1 - Prélèvements multiples de tissu par aspiration à l'aiguille fine (fna) - Google Patents

Prélèvements multiples de tissu par aspiration à l'aiguille fine (fna) Download PDF

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Publication number
WO2014136045A1
WO2014136045A1 PCT/IB2014/059420 IB2014059420W WO2014136045A1 WO 2014136045 A1 WO2014136045 A1 WO 2014136045A1 IB 2014059420 W IB2014059420 W IB 2014059420W WO 2014136045 A1 WO2014136045 A1 WO 2014136045A1
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WO
WIPO (PCT)
Prior art keywords
needle
needles
tissue
inner needle
sheath
Prior art date
Application number
PCT/IB2014/059420
Other languages
English (en)
Inventor
Ziv Belsky
Gilad HIZKIYAHU
Jesse LACHTER
Original Assignee
Rambam Health Corporation
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Rambam Health Corporation filed Critical Rambam Health Corporation
Priority to US14/772,364 priority Critical patent/US20160000415A1/en
Publication of WO2014136045A1 publication Critical patent/WO2014136045A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/04—Endoscopic instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/0233—Pointed or sharp biopsy instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/0233—Pointed or sharp biopsy instruments
    • A61B10/0283—Pointed or sharp biopsy instruments with vacuum aspiration, e.g. caused by retractable plunger or by connected syringe
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B2010/0225—Instruments for taking cell samples or for biopsy for taking multiple samples
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/04—Endoscopic instruments
    • A61B2010/045—Needles

Definitions

  • the present invention is related to medical instrumentation, and more specifically to endoscopic tissue collection.
  • Tissue/Fluid sampling is used in a number of fields, including gastroenterology, cardiology, oncology, radiology, ophthalmology, histology, neurology and neurosurgery, internal medicine, and renal specialties.
  • Such samples are commonly used in the performance of biopsies, or the removal of tissue samples.
  • Biopsies are typically used to help in diagnosing of, for example, a variety of diseases.
  • it is often necessary to take multiple samples in order to increase the accuracy of the diagnosis since a single tissue sample my not represent the entirety of the area, organ, or lesion from which the sample is extracted.
  • the taking of multiple samples can be time consuming, uncomfortable or painful, and may also increase risks of infection.
  • Modern endoscopes are usually flexible instruments comprising a fiber optic viewing system and a tubular channel through which biopsy forceps can be passed to obtain the samples.
  • Some prior art biopsy forceps are designed to obtain a single small piece of tissue on each passage through the endoscope.
  • Such single pass forceps are time consuming to use since clinicians frequently require multiple biopsies of a diseased area in order to gather adequate pathological or other scientific information.
  • the instrument must be passed in and out of the endoscope for each biopsy specimen, and the findings through such procedures are generally limited to visual inspection inside the GI tract.
  • Fine-needle aspiration biopsy FNA or NAB
  • fine-needle aspiration cytology FNAC
  • FNAB fine-needle aspiration biopsy
  • FNAC fine-needle aspiration cytology
  • a thin, hollow needle is typically inserted into the tissue for sampling of cells that, after being stained, may be examined under a microscope. There may also be a cytology exam of aspirate or histological tissue.
  • needle aspiration biopsy is typically safer and less traumatic than an open surgical biopsy, common complications include bruising and soreness. Further, there is a risk, because the biopsy is very small, that the problematic cells will be missed, resulting in a false negative result.
  • FNA is generally implemented through the skin to tissue or organs below the skin, it cannot adequately access tissue or organs covered by bones or under other organs etc.
  • the disadvantage with many currently used devices is that the device must be withdrawn from patient after a single biopsy sample is obtained. Accordingly, it is desirable to extract a number of tissue samples in a minimally invasive manner.
  • EUS-FNA is fine needle aspiration during Endoscopic UltraSound, using an ultrasound equipped endoscope.
  • the endoscope is inserted into the GI tract and its distal end is placed near the desired target organ.
  • the ultrasound detector integral to the device, is activated, and is used to scan organs and tissue adjacent to the GI tract but external to it.
  • a special EUS-FNA needle is passed through the endoscope working channel, punches through the GI tract wall and is guided, under ultrasound, to reach the desired area in the body and obtain a tissue sample for cytological or histological evaluation.
  • EUS-FNA thereby enables inspection of tissues or organs outside the GI tract.
  • making a hole in the GI tract wall carries several risks, including the risk of excessive bleeding, and having material from the GI tract leak through such a hole, creating irritation and probably inflammation in the body.
  • a body lumen wall hole such as a GI tract wall hole
  • a device for endoscopically extracting multiple tissue samples sequentially from a subject, comprising: a sheath; an optionally flexible outer needle; and an inner needle extendable from and retractable into the outer needle having a rotational feature to enable sequential entry of the inner needle at multiple angles relative to the outer needle; and a rotational control mechanism for controlling rotation of the inner needle thereby enabling tissue extraction from multiple locations in a target tissue without sequentially exiting through the lumen wall.
  • the rotational control mechanism is located on a base associated with the outer needle.
  • the inner needle is comprised of a shape memory material such that it forms a pre-configured line of curvature when extended from the outer needle.
  • the shape memory material is a biocompatible nickel titanium alloy (nitinol).
  • the outer needle is adapted to maintain the inner needle in a straight configuration when retracted within the outer needle.
  • a multiple control mechanism is provided to independently maneuver inner and outer needles.
  • a retractable stylet is provided within the inner needle.
  • a device for obtaining multiple biopsy samples, optionally substantially simultaneously, from a body cavity, comprising:
  • an outer sheath multiple inner needles extendable from and retractable into the sheath and being adapted to penetrate a target tissue and to extract samples of the tissue, optionally substantially simultaneously, without sequentially exiting the target tissue, and a control mechanism for controlling the extension and retraction of the inner needles from the sheath.
  • control mechanism is located on a base associated with the needles.
  • each needle has a pre-configured shape.
  • the multiple needles having different pre-configured lines of curvature.
  • At least one needle is straight and at least one needle has a pre- configured line of curvature.
  • control mechanism is adapted to extend the multiple needles simultaneously or individually from the external sheath.
  • each needle is in communication with a distinct chamber for collection of a sample from that needle.
  • each inner needle is substantially straight and a deflecting cap is provided on the outer sheath and/or each needle to deflect the needle at an angle upon exiting the sheath.
  • a method for obtaining multiple tissue samples through an endoscope comprising (i) advancing an endoscopic device having an outer needle and a remotely rotatable inner needle through a body lumen wall, such as a GI tract, the inner needle having a pre-configured curvature and being retracted within the outer needle; (ii) upon reaching a first target tissue site, extending said inner needle from said outer needle to capture a tissue sample, said inner needle adopting its pre-configured curvature; (iii) at least partially retracting the inner needle within said outer needle; (iv) rotating angle of said inner needle; and (v) advancing the rotatable inner needle with a pre-configured curvature to a second or additional location in target tissue to capture a second or additional tissue sample.
  • a method for obtaining multiple tissue samples, optionally substantially simultaneously, through an endoscope comprising (i) advancing an endoscopic device comprising an outer sheath with multiple inner needles through a body lumen wall, such as a GI tract, each of the internal needles optionally having a distinct pre-configured curvature and being retracted within the external sheath; (ii) upon reaching a target tissue site, extending one or more of the inner needles through the body lumen wall to multiple locations within a target tissue, to capture multiple tissue samples; and (iii) at least partially retracting one or more of the inner needles into said outer sheath.
  • the devices and methods of the present invention are particularly suitable for fine needle aspiration biopsies (FNA), especially fine needle aspiration during endoscopic ultrasound (EUS-FNA).
  • FNA fine needle aspiration biopsies
  • EUS-FNA endoscopic ultrasound
  • FIGS. 1A-1D are graphical illustrations of a rotatable, pre-curved coaxial EUS- FNA device, enabled to reach tissue at multiple targets substantially through a single entry hole in the target location/organ, according to some embodiments;
  • FIGS. 2A-2G are graphic illustrations of a multiple needle EUS-FNA device enabled to reach tissue at multiple locations substantially simultaneously, according to some embodiments;
  • FIG. 3 is a is a flowchart illustrating a series of operations or processes that may be implemented to enable tissue extraction from multiple locations, using a EUS-FNA device with a rotatable tissue capture needle, as illustrated in Figs. 1A-1D; and
  • FIG. 4 is a flowchart illustration showing a series of operations or processes that may be implemented to enable substantially simultaneous tissue extraction from multiple locations, using a EUS-NFA device with multiple tissue capture needles, as illustrated in Figs. 2A-2G.
  • an FNA needle able to reach multiple points in a target tissue when it is inserted once through a hole made in the GI tract wall, obviating the need to extract the needle back through the GI tract wall during a procedure.
  • different locations for tissue sampling may be reached sequentially in a single entry into a target organ.
  • different locations for tissue sampling may be reached substantially simultaneously.
  • tissue removal from multiple locations may be enabled within a substantially single EUS-FNA procedure, by using a rotatable bending shaped needle adapted to extract tissue in multiple locations.
  • Figs. 1A-1C are graphical illustrations of a rotatable, pre-curved coaxial needle device 100, for endoscopically extracting multiple tissue samples sequentially from a subject, according to some embodiments.
  • the needle may be made from a flexible metal or constructed at least partially from Nitinol or another shape based material. Of course, other suitable materials may be used.
  • the device components may include an external sheath 105, optionally flexible, for delivering the device through a body lumen wall, housing an optionally flexible outer needle 110, suitable to be delivered endoscopically.
  • sheath 105 has an outer diameter of -2.1 mm and an inner diameter of -1.3 mm. Of course other dimensions may be used.
  • outer needle 110 may have a size of ⁇ 19ga, and have an OD of ⁇ 1.076mm and IN of ⁇ 0.68mm. Of course other dimensions may be used.
  • the inner needle may be constructed from a flexible material, and in some cases, at least partially from a shape memory material such that it forms a pre-configured line of curvature when extended from the outer needle.
  • the shape memory material is a biocompatible nickel titanium alloy (nitinol).
  • the inner needle may have a size of ⁇ 25ga, and have an OD of ⁇ 0.52mm and an IN of ⁇ 0.26mm. Of course other dimensions may be used.
  • stylet 120 may have a diameter of ⁇ 0.16mm. Of course other dimensions may be used.
  • the device includes a a rotational control mechanism for controlling rotation of the inner needle thereby enabling tissue extraction from multiple locations in a target tissue, without exiting a target organ.
  • the rotational control mechanism is located on a base associated with the outer needle.
  • needle device 100 may be at least 100 cm long (i.e., to be suitable to be used with an endoscope, whether less or more than 100 cm) and may in its entirely to be able to substantially bend, for example, to enable forming a circle with a diameter of 30 cm (or more or less).
  • the outer needle is adapted to maintain the inner needle in a straight configuration when retracted within the outer needle.
  • a multiple control mechanism is provided to independently manuever both the inner and outer needles.
  • a retractable stylet is provided within the inner needle.
  • the inner needle is adapted for therapy delivery.
  • the device may also have an FNA system handle 125 with added knob(s) or control dial(s) for internal needle insertion and rotation control.
  • a Nitinol needle may have a pre- configured curvature, for example, like the curvature of the circumference of a 3 cm diameter circle, however, other suitable shapes or forms may also be used.
  • the pre- shaped inner needle 115 is adapted to be rotatable while inside an outer needle 110, so that when pushed out of a sheath 105, inner needle 115 will curve in a different direction toward the target tissue.
  • Outer needle 110 is adapted to be sufficiently hardened to enable the curved inner needle to be maintained in a substantially straight position when inside the outer needle. Further, the relative angle of the inner needle 115 and outer needle 110 should be indicated on the handle 125, to help the practitioner maneuver the needle to different targets. Further, signing or angle measurement indications may be provided on handle 125 to indicate the relative angle between inner needle 115 and outer needle 110, relative to a pre- set reference angle. In some embodiments, inner needle 115 may be filled by an extractable stylet 120 that, when fully inserted within inner needle 115 reaches its tip, to protect the inner needle entry point so it only grabs target tissue when stylet 120 is retracted.
  • the end of the hollow inner needle may be attached to a connector on handle 125 (e.g., on the middle of back part) that allows connection of the inner needle to a suction source, to enable suction to be implemented from the tip of the needle.
  • a connector on handle 125 e.g., on the middle of back part
  • a multiple-level control mechanism may be used to maneuver outer and inner needles in the EUS-FNA procedure, to enable rotation of the inner needle while inside the outer needle.
  • two or more handles or guide elements may be used to control both the inner needle and outer needle linear position relative to the external sheath and also the inner needle angle relative to the outer needle during a procedure.
  • the outer needle may be extended to penetrate the tissue, thereby reaching a desired location in the sample area to be extracted.
  • the inner needle may be extended as deeply as needed into the target tissue (e.g., the pancreas). As can be seen, the natural bending of the needle can occur during tissue penetration.
  • the inner needle may be retracted, optionally all the way back into the outer needle, following a tissue sampling, which appears similar to the device shown in Fig. IB.
  • one or more additional samplings may be conducted without extracting the EUS-FNA device, by rotating the inner needle (e.g., 45 90°) using the base knob and then extending the inner needle again, as may be necessary.
  • the natural bending may herein occur during tissue penetration on a different plane, as can be seen.
  • the rotation and re-execution may be conducted multiple times.
  • the device may be retrieved or extracted, and flushed or cleaned using, for example, air or fluid, to extract the tissue samples for testing. Needles may be discarded or sterilized for further use.
  • a suction source may be applied to the base of inner needle 115 through a standard connector in handle 125 (not shown), to help harvest the tissue sample and store it within the needle until flushing, as is known in the art and commonly practiced with existing EUS-FNA needles.
  • multiple location tissue removal is enabled using a tissue sample removal device with multiple needles adapted to acquire tissue from multiple locations simultaneously.
  • Figs. 2A-2B are graphic illustrations of a multiple needle/capture EUS-FNA device 200 enabled to remove tissue from multiple locations simultaneously, according to some embodiments.
  • device 200 components include an external sheath 205 that holds multiple inner needles 210, optionally with inner Stylets 215, to prevent entry of tissue materials into needles until after the stylets are removed.
  • the respective inner needles may be contained within distinct lumen (i.e. multiple inner lumen) to prevent inner needle buckling.
  • each inner needle has a pre-configured shape, and/or may have different pre-configured lines of curvature.
  • At least one needle is straight and at least one needle has a pre-configured line of curvature.
  • each needle is in communication with a distinct chamber for collection of a sample from that needle.
  • each inner needle is substantially straight and a deflecting cap is provided on the outer sheath and/or each needle to deflect the needle at an angle upon exiting the sheath.
  • multiple retractable stylets are provided within the inner needles.
  • the control mechanism is located on a base associated with the needles. Further, the control mechanism may be adapted to extend the multiple needles simultaneously or individually from the external sheath.
  • Figs. 2A-2B show one example of the inner design of such a FNA device, however other configurations may be used, with different scales, numbers of lumen etc.
  • Figs. 2C-E are graphical illustrations of an example of device 200 being deployed, wherein the different pre-configured curvatures of the respective inner needles can be seen, as they are advanced.
  • device 200 may include multiple Inner needles 210, for example ⁇ 25ga, which may be pre-curved or not.
  • a 22GA needle may be used, 3 needles around it of 25 GA size.
  • a sheath 205 may have an OD of +2.7mm, and it may contain multiple lumen, for example 5 lumen of +0.62mm diameter each, or one central lumen of +0.8mm and 3 or 4 surrounding lumen of +0.62mm each.
  • inner needles may have an OD of +0.52mm and an IN of +0.26mm. Of course, other dimensions may be used.
  • Device 200 may also include multiple stylets 215, within inner needles 210, one stylet within each needle.
  • stylet 215 may have a diameter of +0.16mm.
  • a deflecting cap that connects to the sheath may be provided, to enable protection of the entrance of the inner needle so as to minimize the entry of unwanted materials during a procedure.
  • a deflecting cap that connects to the sheath may be provided, to enable protection of the entrance of the inner needle so as to minimize the entry of unwanted materials during a procedure.
  • other dimensions may be used, and other numbers, sizes, types etc of needles may be used.
  • the device 200 may include multiple chambers, one for each inner capture needle, for simultaneous collection of samples.
  • the device may maintain separate containment and extraction areas and ports, to help a practitioner or tester know which location each sample was taken from.
  • Figs. 2F-2G are graphical illustrations of examples of further embodiments of device 200, which may include multiple handles or other controls for maneuvering the respective inner needles.
  • the respective inner needles may be advanced simultaneously to the target tissue to acquire tissue samples.
  • the respective inner needles may be individually advanced via the respective control dials or mechanisms, optionally with individual measurement panels to help the practitioner advance each inner mechanism to a preferred distance.
  • Fig 2G illustrates the scenario where only two inner details were advanced, and these were advanced to different distances, in accordance with the practitioners determination.
  • FIG. 3 schematically illustrates a series of operations or processes that may be implemented to enable tissue extraction from multiple locations, using an EUS-FNA device as illustrated in Figs. 1A-1D.
  • an EUS FNA device may be inserted into the working channel of an already positioned ultrasound endoscope (EUS). It is important to note that prior to use, EUS-FNA device is typically set so that both the outer and inner needles are fully retracted into the sheath, and a stylet is typically fully inserted into the inner needle.
  • the EUS-FNA device may be extended to a position where a practitioner wishes to penetrate the GI tract to access a target tissue or organ.
  • an endoscope having an outer needle and a rotatable inner needle is rotated through a wall of a body lumen, such as the GI wall.
  • the inner needle has a pre-configured curvature, and is retracted within the outer needle.
  • the outer needle may penetrate the GI wall and continue to be advanced until near the target sampling site.
  • the stylet may be removed to enable the inner needle to be readied for tissue capture.
  • suction may be applied to the inner needle, to aid tissue capture.
  • the inner needle may be extended from the outer needle, to capture a tissue sample from a target location, wherein the inner needle adopts its pre-configured curvature, to enable tissue sample capture.
  • the needle While the needle is extended it may bend or curve in accordance with its natural or pre-configured properties, for example, along a pre-determined plane, thereby reaching the desired site for tissue sampling.
  • the suction to the inner needle may be discontinued.
  • the inner needle may be retracted at least partially back into the outer needle.
  • the inner needle may be rotated, for example between 10°- 170° or more specifically between 45°-90°, using the base knob or other rotating device, within the outer needle.
  • suction may be re-applied to the inner needle.
  • the inner needle with a pre-configured curvature may be extended again to enable tissue penetration on a different plane or at a different angle, to enable tissue capture at a second (or additional) location.
  • Steps 338-355 may be repeated numerous times to enable tissue capturing in the inner needle from multiple locations.
  • the inner needle may be retracted out of the patient, and the tissue samples may be flushed or otherwise removed from the needle for storage or analysis. Suction may then be applied at block 330, and the inner needle may be re-entered all the way until it extends from the outer needle, optionally at a second or alternative angle or position, at block 335 to continue with the work flow as before.
  • the EUS-FNA device may be extracted entirely and the sample(s) extracted typically by flushing the needle.
  • the EUS-FNA device may optionally be cleaned/prepared for re-use. Any combination of the above steps may be implemented. Further, other steps or series of steps may be used.
  • tissue grabbing, cutting or extraction elements may be used.
  • cleaning, flushing or extracting mechanisms may be used to release the tissue samples from the FNA device.
  • FIG. 4 schematically illustrates a series of operations or processes that may be implemented to enable tissue extraction from multiple locations substantially simultaneously, using an EUS-FNA device as illustrated in Figs. 2A-2G.
  • an EUS-FNA device may be inserted into an already positioned EUS endoscope and advanced through the endoscope working channel all the way towards the tip.
  • the needles may be advanced to the GI wall penetration location.
  • one or more needles, optionally having one or more pre- configured curvatures may be further advanced to penetrate the GI wall and further advanced towards the target site.
  • one or more stylets may be removed from the inner needles.
  • suction may optionally be applied to one or more inner needles to help tissue capture.
  • one or more inner needles are extended as deeply as needed, to penetrate and acquire tissue samples.
  • suction to the inner needle may be discontinued.
  • the inner needles may be retracted into the device sheath.
  • the EUS-FNA device may be extracted from the endoscope, and the samples removed for further storage or analysis from the needles by way of flushing or any other method known in the art. In some cases sample extraction may require rinsing/dispensing the device. In some cases the EUS-FNA device may cleaned/prepared for re-use. Any combination of the above steps may be implemented. Further, other steps or series of steps may be used.
  • substantially straight inner needles may be used, optionally with needle caps (on the sheath) that deflects the needles at respective angles when they exit the sheath.
  • alternative mechanical elements may be used to maneuver the inner needles at different angles.
  • one or more of the multiple inner needles may be individually maneuvered.
  • multiple tissue collection methods may be used in the above described systems and methods.
  • brushing or drilling may be implemented, for example using a rough drilling stylet.
  • a moving elevator mechanism may be used in conjunction with the described EUS-FNA device(s).
  • the device may include multiple chambers for storage and optionally for simultaneous flushing/collection of samples.
  • the separate ports may be used to know where each sample has been taken from.
  • different handles or control may be used to maneuver or control the different inner needles.
  • therapeutic treatments or drug delivery may be implemented using the devices described above.
  • elastography may be integrated during the tissue sampling procedure.
  • needles of different length, strength, materials etc. may be used.

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Abstract

La présente invention concerne un appareil, un dispositif et un procédé d'extraction endoscopique de multiples échantillons de tissu de multiples emplacements sans qu'il ne soit nécessaire de complètement retirer l'appareil ou le dispositif du tissu cible au cours du processus. Dans certains modes de réalisation, le dispositif comprend une gaine pour délivrer le dispositif à travers une paroi de lumière corporelle, une aiguille extérieure, une aiguille intérieure pouvant se projeter de l'aiguille extérieure et se rétracter dans ladite aiguille intérieure, l'aiguille intérieure ayant un élément de rotation pour permettre l'entrée séquentielle de l'aiguille intérieure à de multiples angles relativement à l'aiguille extérieure ; et un mécanisme de commande de rotation pour commander la rotation de l'aiguille interne, permettant ainsi l'extraction de tissu de multiples emplacements dans un tissu cible, sans séquentiellement sortir de la paroi de lumière corporelle.
PCT/IB2014/059420 2013-03-04 2014-03-04 Prélèvements multiples de tissu par aspiration à l'aiguille fine (fna) WO2014136045A1 (fr)

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US14/772,364 US20160000415A1 (en) 2013-03-04 2014-03-04 Multiple-tissue fna sampling

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US61/772,059 2013-03-04

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WO2017037720A1 (fr) 2015-09-06 2017-03-09 Fna Technologies Ltd. Dispositif de manipulation d'aiguille
US11253236B2 (en) 2019-10-21 2022-02-22 Onepass Medical Ltd. Needle-handling device
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US10912542B2 (en) * 2018-03-14 2021-02-09 Spiration, Inc. Catheter assembly with offset device for tissue sampling
US20190282218A1 (en) * 2018-03-14 2019-09-19 SPIRATION, INC., d/b/a OLYMPUS RESPIRATORY AMERICA Catheter Assembly With Offset Device For Tissue Sampling
DE102018132018A1 (de) * 2018-12-13 2020-06-18 Otto-Von-Guericke-Universität Magdeburg Biopsienadel
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